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Plague in Madagascar

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

What is the current situation?

In early October, World Health Organization and the Madagascar Ministry of Health responded to an unusual outbreak of plague pneumonia in widespread areas of Madagascar, including in heavily populated cities of Antananarivo (the capital city and its suburbs) and Toamasina. In late November 2017, the Madagascar Ministry of Health declared the urban outbreak of plague pneumonia had been contained. However, bubonic plague occurs nearly every year in Madagascar, so travelers to the area should continue to take precautions to protect their health.

What is plague?

Plague is a bacterial infection that is usually spread through bites by infected fleas. When acquired by flea bite, plague causes symptoms of high fever and swollen and tender lymph nodes (bubonic plague) that usually occur 2–6 days after the bite. If it is not treated, the infection can spread to the lungs and cause pneumonia.

Plague pneumonia (or “pneumonic plague”) is the only form that can be directly transmitted from one person to another. In rare but serious cases, a person with severe plague pneumonia can spread the infection directly to others by coughing up droplets that contain the plague bacteria. These bacteria-containing droplets can cause pneumonic plague in another person if breathed in (more information). Symptoms of plague pneumonia typically appear 2–4 days after inhaling plague bacteria and usually include sudden onset of high fever and cough and other general symptoms such as headache, chills, and weakness.

Plague can be treated with antibiotics. However, without prompt treatment, plague can cause serious illness or death.

How can travelers protect themselves?

No vaccine is available to prevent plague. But travelers can take steps to prevent plague, and plague can be prevented with antibiotics. Travelers to Madagascar should

  • Use EPA-registered insect repellent that lists protection against fleas on the label and contains at least 25% DEET.
  • Avoid close contact with sick or dead animals.
  • Avoid close contact with seriously ill people, especially people who are coughing up blood.

Travelers who have had close contact with people with plague pneumonia should immediately notify a health care provider. They may need to take antibiotics to prevent plague.

During or after travel to Madagascar, travelers should be alert for symptoms of plague. If symptoms do appear, they should seek medical care and inform the provider about their travel to Madagascar.

Learn more about plague, how to prevent it, and what to do if you think you are infected at CDC’s plague page for travelers.

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